HOUGHTON
Many people think that because something is natural it’s safe. But if you stop and think quite a lot of the most poisonous things we know actually come from natural sources, there are obviously things like the venoms from snakes and spiders, but even from plants there’s things like strychnine, which many people would know as a poison, many of the fungi produce poisonous substances and of course bacteria produce nasty toxins like botulin.

FORD
So just as nature’s poisons can in tiny doses be made into some of our most effective medicines, for Peter Houghton, Professor of Pharmacognosy in the Department of Pharmacy at King’s College in London, natural treatments using some herbal preparations remain an area of concern.

HOUGHTON
There are three main reasons why they can be harmful. Because they are medicines you’ve got the same problems of overdosing in some circumstances with some patients as any ordinary medicine would have. The second problem is that you sometimes get contamination or complete substitution with a more dangerous substance. The third area, which we’re only just beginning to explore, is where they interact with ordinary medicines, either to exaggerate the effect - so you might get toxicity - or they go against the effects so you don’t get the effect you want.

FORD
One of the more adverse interactions is found with the plant St John’s Wort. Commonly prescribed for mild depression by herbalists and bought over the counter by thousands of consumers, with Warfarin, a blood thinning agent, the interaction can be deadly, and it can render the contraceptive pill ineffective.

MILLS
We’re in my dispensary, herbal dispensary, and here we have rows of bottles in tincture form - tincture is a solution of a dried herb in a mixture of alcohol and water, it keeps it - preserves it - for many months and is a very convenient way of dispensing it. We have Echinacea, a herb widely used by the public in the shops, from the pharmacies and so on, as a support for immune defences, as protection against respiratory and other infections. We need to do quite a lot more research and see what its real potential is.

FORD
Simon Mills is a herbalist and co-founder of the Complementary Health Studies Unit at the Universities of Exeter and Plymouth. One of the important issues in herbal medicine, apart from toxicity, is quality control. With a UK market worth in excess of £100 million a year, making sure remedies contain what they’re supposed to is getting harder.

MILLS
These plants are derived from all over the world in different circumstances. In the past there have been fairly rigorous quality control measures, simply because the people in the market were experts at it and they needed to buy the right quality of stuff for their customers, their clients, who were conventional drug manufacturers very often. Nowadays it’s a bit more open and we are concerned about the quality of some of the material that reaches the market. For example, in the United States where it’s a very wide open market over half of the herbs found in studies, in surveys, have been found to be of poor quality. Now that means that at very least you’re not buying what’s on the label but at worst it could mean you’re getting a substitution or you’re getting something that might even harm or hinder your healthcare.

FORD
Increased regulation of herbal medicines, particularly those used by traditional Chinese practitioners, is one way to ensure better quality and safety. The body charged with drawing up guidelines: the Medicines and Healthcare Products Regulatory Agency continues to be concerned over these issues and recently reminded herbal practitioners that they will "not hesitate to take enforcement action including prosecution where products pose a risk to public health".

But whilst the quality of medicine is important, so too is the quality of advice given by CAM practitioners. The majority of therapists belong to associations or societies which lay out codes of practice. However, at the moment, there’s no legal requirement for them to follow these codes and on certain issues, a considerable number don’t.

Researcher Katja Schmidt from the Department of Complementary Medicine at the Universities of Exeter and Plymouth discovered this when she sent out an e-mail to GPs, homeopaths and chiropractors asking them for advice about immunisation.

SCHMIDT
We contacted those people in which a mother asked for advice regarding the MMR vaccination for her one year old child. And altogether we contacted 168 homeopaths of whom 72% responded and we also contacted 63 chiropractors, of whom 44% responded. I have to point out that not a single general practitioner responded to our query. And what we found really is that only a few professional homeopaths and about a quarter of the chiropractors that we contacted and that responded advised in favour of the MMR vaccination and almost half of the homeopaths and nearly a fifth of the chiropractors advised against MMR vaccination. So really what we can say is that some providers of complementary medicine are advising people against government policy and general practitioners, on the other hand, seem not to respond at all to patients’ e-mails on this very delicate matter.

FORD
The fact is that increasing numbers of parents are exploring alternative ways of protecting their children from infectious diseases. Acupuncturist Nancy Holroyd Downing believes an alternative way of viewing health doesn’t necessarily fit with the conventional view of immunisation.

This remains a highly debated issue both within CAM but also between CAM and orthodox medicine. But are practitioners like Nancy right to offer advice?

HOLROYD DOWNING
What I try to do, because this is a fractious argument and this is something that is not only a source of a lot of anger but it’s a source of a lot of soul searching on the parts of parents and I don’t …

FORD
And guilt as well.

HOLROYD DOWNING
And guilt and I do not want to contribute to the bad stuff there. What I say to people is that there are a number of ways to look at the whole notion of childhood illnesses and there are a number of ways to treat those illnesses either preventively or after the fact. Measles is not bubonic plague, people do and did survive - I survived measles …

FORD
Yes so did I and my brothers as well.

HOLROYD DOWNING
And I think the public health issue is relevant here. I think if a parent chooses to have their child immunised it’s a perfectly reasonable decision to make.

FORD
Because measles does have potentially very large numbers of complications doesn’t it.

HOLROYD DOWNING
Yes it does.

FORD
And some children, very few, might become seriously ill. Now if we didn’t have vaccination and we only used Chinese medicine do you think we could protect as many children as we do by vaccinating them?

HOLROYD DOWNING
I don’t know quite honestly the answer to that question. I don’t think we can say that if there was not measles vaccine we would have - I don’t think, I mean I’m willing to be proved wrong here - I don’t think we would have scores of children dropping dead.

FORD
We’ll that’s one view and we’ll examine what the professional bodies governing different CAM practices have to say on this and other issues in more detail next week when I’ll look at the regulation of CAM. But Dr Peter Fisher, Head of the Royal Homeopathic Hospital in London is adamant that immunisation is an advance in child health care.

FISHER
One of the things that annoys me particularly when you hear people who are not members of health professions denouncing immunisation - it’s what I call the spoilt brat school of medicine, they’ve never seen diphtheria or polio, they assumed it didn’t exist - it never existed or those things weren’t the terrible diseases that they are. The fact is the reason they’ve never seen them is that immunisation is an extremely effective treatment and kids don’t get paralysed from polio, they don’t die of diphtheria anymore and it’s entirely down to immunisation.

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